Type 1 Diabetes Support Form

Do you meet the following criteria:

1. Child seeking help has type 1 diabetes & hasn’t turned 19.
2. B.C. resident for a minimum of three months with a valid Care Card.
3. Financial circumstance that limits the ability to afford the item or service required (Variety is currently able to consider requests from households with an annual income of up to $108,333).
4. You must be using a Dexcom continuous glucose monitor (CGM). If you are not already using a Dexcom CGM, you must get a special authority to be eligible for coverage.

Before filling out this application:
1. Confirm your PharmaCare Maximum Benefit Amount. (Family maximum levels are listed here, on the far right column.) To obtain your current PharmaCare Maximum Family Deductible, call 604-683-7151 or 1-800-663-7100, follow the prompts for PharmaCare and wait to speak with an agent. They will give you the number over the phone.

2. Variety requires written proof of your deductible. You will have to upload your Confirmation of Fair PharmaCare Assistance letter from Health BC. This can be obtained by applying online. Your letter of confirmation may take up to 3 weeks to be delivered. Once received it should be scanned and uploaded to the form below.

3. You will need the contact information for the prescribing physician and the child’s pharmacy (if applicable). Please have this information handy as you begin filling out this form.